DRUJ/TFCC Injuries and Treatment-TFCC

Video Transcription

Thanks, Chuck. Thanks, Mark and Chuck. So my task is to talk a little bit about open TFCC repair, which in my hands I use for associated distal radial inner joint instability.  So we talked that with the widespread use of arthroscopy, the indications for open TFCC repair are limited in my practice primarily to the setting of a patient with a TFCC tear  and associated DRUJ instability.  Longitudinal incision is made at the dorsal portion of the wrist and the EDQ is open, the fifth dorsal extensor compartment, and the EDQ is retracted.  We make an L-shaped capsulotomy for the DRUJ and a second transverse capsulotomy for the ulnar corporal joint. The TFCC is inspected and the fovea is debrided,  and bony tunnels are placed from the dorsal ulna, from proximal to distal, to the fovea. I use 2-0 PDS sutures. They're passed through the TFCC and then tied.  The patient's placed in a Munster or sugar-tongue splint for four to six weeks. So here's the video. Start out with examination of the patient.  So this patient has gross instability of the DRUJ in all positions, pronation, supination, and neutral, after a sports-related injury.  And here's the incision made over the dorsum of the wrist. The fifth dorsal extensor compartment's identified. Here's the distal ulna.  Here's the fifth compartment, the ECU, over here. And then, subsequently, the fifth compartment is opened and the EDM is identified and retracted out of the way.  Again, here's the distal ulna. Here's the ECU. We're making an L-shaped capsulotomy, a second capsulotomy at the ulnar corporal joint.  And we're taking care not to injure the TFCC during the capsulotomy. Fovea is debrided, and sutures are passed through the TFCC through the two capsulotomies,  the transverse ulnar corporal capsulotomy and then the L-shaped DRUJ capsulotomy. You can use Keith needles to pass bony tunnels  and then tie the sutures over the bone in supination or neutral. And here we're closing and imbricating the capsule and the retinaculum,  leaving the extensor digiti minimi out and free. And then, subsequently, the patient is tightened up nicely compared to the preoperative images that you saw before,  and she has full pronation, supination, and neutral. So thanks very much. Thanks, Julie.

Video Summary

In this video, the speaker discusses open TFCC (triangular fibrocartilage complex) repair for associated distal radial inner joint instability. The speaker explains that open TFCC repair is primarily used when a patient has a TFCC tear and associated DRUJ (distal radioulnar joint) instability. The procedure involves making a longitudinal incision at the dorsal portion of the wrist, opening the fifth dorsal extensor compartment, and retracting the extensor digiti quinti. Capsulotomies are performed for the DRUJ and ulnar corporal joint, and the TFCC is inspected and debrided. Bony tunnels are created from the dorsal ulna to the fovea, and sutures are passed through the TFCC and tied. The patient is then placed in a splint for four to six weeks. The video also includes footage of an actual procedure, showing the incision, identification of anatomical structures, capsulotomy, suturing, and final outcome. The summary concludes by giving thanks to the speakers and mentioning that the patient's range of motion improved after the surgery.

Keywords

open TFCC repair

triangular fibrocartilage complex

DRUJ instability

wrist surgery

capsulotomy